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Home My WebLink About5039-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at $te~.-Ro~5 ................ Street Map No. '~4~lt. Creek B~c~ No ........... Lot No. ~ .... llouthol~.. I~.X. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~o~ ..... 2 ...., 19. ?D pursuant to which Building Permit No. '5039~ ' dated .......... ~.o.v....2 ..... , 19. ?.0., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . Donald. & .~Iel®n. F~deriok .... O~n~8 ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .!~..?. ~.~.3.. b~..R,. Y. iXI& ....... UNDERWRITERS CERTIFICATE No.. ~]1~ ....................................... HOUSE NUMBER..~ ....... Street .....(~'l el'tr~ .P~&~ ................................ FOltM N0. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ) BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE? UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) 5039 Z Permission is hereby granted to: hO ¢j~ L ~' ~l~ ~ C' ' ' ~- ' - . .~ ~ ~.,~:~.: to .............................................................................. t,~ .......... , .......... ¢; .... : .......................... et premises I~otod at ....... r::..~..~...: .................. [ ,~..:. ~ 1~ ~ ~ ~ ~ ~ ~ ~a ~)~ t .......................................~ ~:. ................................ ~e o .~ ~ ........... ~ ......... ~:~: ~ ~,~~.~ ;.~...: ....... ,~..:~ ........ ,.. ...................... pursuant to application dated .................. ¢......~ ........... ;~..:.; i9~.¢};, O*d op.rov~ by the Building Inspector. . ( , , ' ¢~:,: ,' , , If ..... : . S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH pat s MAY ? ~973 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilitims for a structure located ''~ ~ ~ (Give deed location~ · have been inspected by this department and found to be satisfactory. APPLICATION FOR BUILDING PEKMrT Date ..... ~.,.~ .............................. . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad|ainlng pmmleee or public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram whlch i~ part of ~hie ¢~llcatlon. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Ir~pector will Issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. RB .A, .P. PLI,CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit punluant to the u.a~ng ~:one Ordinance of t.he Town of .Southold, Suffolk Count, New York, and other .pppllce~le ~ Ordinance, or egu~ations, for the construction of bulld,ngs, additions or alterahons, or for removal or demolition, al heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, hoyslng cede, anf regulations. . ,....., ........... (Signature cf applicant, or name, If a ca, oration) ....................... ..................................... ..... / (Address o? at~llcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elactrlclon, plumber or builder. ..... ................................................................................................................ owner .~ e ~'~ ~- '~' -- ~-' Name of o f premises. ~...Q. ~../~ ./~......~., ,....~.. ~.~ ............. ,../~.. ....... . ..~.. ~.~)...~.. ~../.....~.. ........................ If applicant Is a co~omte, slgna~re of duly authorlz~ officer. (Name a~ title 'of co~orate officer) . -- ~ 1. ~ati~ of land on ~lch p~ ~ will ~ dane. ~ap No.: ........................................ ~ ~.: ...~.~ ...........~ s,~,, ~nd ~,m~, ... ~ ~.Z. ......... ~.~.~.~....~...~ ............ ~~..~ ...... ~.~ ............ 2.S~te existing u~ and ~cu~ncy of promises and intended use and ~cu~n~ of p~ c~tm~l~: a. ~isting u~ ~ ~cupancy ................................................................................................................................... Intended use and occupan? . ................................. ~ ............... Nature of wmk (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .............. ,.. Other Work (Describe) ...................................... Estimated Cost ............................................................ Fee ......................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ........................... Number of dwelling units on each floor ........................ If garage, number of cars ......................................................................... : .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ........... Height ........................ Number of Stories ................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... '..; ...... ;...; ............. Rear ............................ Depth ........................ Height ..................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ................. J ...................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~(,ORJ~, ~1 'lee COUNTY Of ..,,,%~C. ........... }'~'~' ................. ,t..~..OS~.'l~ ........ ~. ....... ~X';~?~ ............... being duly sworn, deposes and says that he is the applicant '(Name of individual signing application) above named. He is the ........................ ~.ld~./~',~ff. ....................................................... 'j ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ....... Ho, ~-~2§~50, Suffolk